To Fight Opioid Epidemic, Pain Management Survey Won't Be Tied to Medicare Payment

Yesterday's announcement featured several steps to combat opioid addiction, including expanded access to buprenorphine, steps to educate physicians, and controls on prescription programs through the Department of Defense and the Indian Health Service.

The Obama Administration announced several steps to combat the nation’s opioid epidemic yesterday, including a plan to drop patient survey questions about pain management from scores that are tied Medicare payments. Advocates for the change say breaking this link is critical, because hospitals and doctors can feel pressured to prescribe opioids to avoid poor scores from patients.

This change is one of several steps HHS Secretary Sylvia Mathews Burwell announced to prevent people from becoming addicted to prescription painkillers and to treat those who already are. The tale of opioid addiction after surgery or an injury, and subsequent heroin use is common and deadly, CDC reports. Since oxycodone became widely available in the mid-1990s, the number of deaths from heroin has quadrupled alongside a similar rise in prescriptions.

Plans outlined by Burwell yesterday include:

· A proposal from CMS to remove survey questions on pain management from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). While the announcement states that the survey questions have limited effect on Medicare’s value-based purchasing model, the perception among doctors may differ.

· HHS is finalizing a rule to increase from 100 to 275 the number of patients who can be prescribed buprenorphine from qualified physicians. Prescribing the drug takes a special certification, and the cap limits the number of patients who can get this drug, which reduces heroin and opioid cravings. The change will improve access for patients seeking treatment.

· HHS issued a Request for Information seeking comment on current physician education programs on how to properly prescribe opioids, as well as ideas for future programs in Medicare. It has been shown that the Medicare Part D program, which started in 2006, quickly became the largest payer of opioids.

· Special steps to improve addiction treatment, or stop interruption of treatment, for veterans being treated through the Veterans Administration.

· Increased monitoring of prescription drug prescribing and distribution through Department of Defense programs and the Indian Health Service.

The United States had more deaths from drug overdoses in 2014 than any year on record, with CDC reporting the death rate from overdoses was one and half times higher than that from motor vehicle accidents. The 137% spike in the death rate since 2000 has been driven almost entirely by the rise in heroin and other opioid-related deaths, according to CDC.

Kelly Clark, MD, MBA, president-elect of the American Society of Addiction Medicine, said earlier this year there has been a 183% increase in opioid use just in the last 7 years, and an estimated 5% of the population uses the drugs for a non-medical reason.

Rural America, and the South in particular, has been hard hit by the crisis. Last week, the Department of Agriculture announced $1.4 million in grants to Kentucky to expand Distance Learning and Telemedicine to bring counseling programs in a state hit especially hard by the epidemic.

“More Americans now die from drug overdoses than car crashes, and these overdoses have hit families from every walk of life and across our entire nation,” Burwell said. “At HHS, we are helping to lead the nationwide effort to address the opioid epidemic by taking a targeted approach focused on prevention, treatment, and intervention. However, if we truly want to turn the tide on this epidemic, Congress should approve the President’s $1.1 billion budget request for this work.”